No abstract

OBJECTIVE: To assess the incidence and ultrasonographic characteristics of cesarean scar niches after uterine closure by double-layer barbed suture.DESIGN: This was a prospective case-control study. MATERIALS AND METHODS: Women who underwent elective cesarean section at R 38 weeks of gestation were enrolled. Exclusion criteria were a previous cesarean section or uterine surgery. Low transverse hysterotomy was closed either by a double-layer unidirectional barbed suture or by a conventional double-layer smooth suture. The choice of the suture was based on the preference of the surgeon. The first uterine layer was done by continuous unlocked suture, including the endometrial layer and the second layer by continuous unlocked suture imbricating the first. Saline contrast hysterosonography was performed 6 weeks, 6 and 12 months after the surgical procedure. According to the modified Delphi procedure, a niche was defined as an indentation at the site of a Cesarean section with a depth of at least 2 mm. The niche depth was evaluated perpendicular to the uterine wall and was measured as the shortest visible distance between the apex of the niche and the delineation of the endometrium. Postoperative complications were recorded.RESULTS: The study included 156 women; 94 patients underwent uterine closure by barbed suture and 145 patients by smooth suture. Six weeks after delivery, the residual myometrium thickness (AE SD) was significantly higher in the barbed suture group (4.9 AE 1.6 mm) than in the smooth suture group (4.2 AE 1.5 mm; p<0.001). At 6-month follow-up, the incidence of overall niche was significantly lower in the barbed suture group (20.5%, n¼17/83 vs 34.1%, n¼45/132; p ¼ 0.032). The incidence of complex niche was not different between the two groups (9.6%, n¼8 vs. 7.8%, n¼10; p¼0.595). The mean (AE SD) niche depths and largest diameters were 2.5 AE 1.4 mm and 1.9 AE 1.1 mm in the barbed suture group and 3.7 AE 0.7 mm and 2.9 AE 1.0 mm in the smooth suture group (p¼0.001 and p¼0.002), respectively. At 12-month follow-up, the incidence of niche remained significantly lower in the barbed suture group (21.1%, n¼15/76 vs. 30.5%, n¼39/118; p¼0.042). There was no significant difference in the incidence of postoperative complications between the two groups.CONCLUSIONS: The use of double-layer barbed suture during cesarean section seems to lead to a low incidence of scar niche formation and reduced size of the niches in patients who have developed them.

No abstract

No abstract